Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

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Management of perforated peptic ulcer in a district general hospital

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13165261994030 ◽

2011 ◽

Vol 93 (8) ◽

pp. 615-619 ◽

Cited By ~ 9

Author(s):

AC Critchley ◽

AW Phillips ◽

SM Bawa ◽

PV Gallagher

Keyword(s):

Hospital Stay ◽

General Hospital ◽

Laparoscopic Repair ◽

Open Repair ◽

Elective Surgery ◽

Operating Time ◽

Laparoscopic Group ◽

District General Hospital ◽

Open Group ◽

Peptic Ulcers

INTRODUCTION Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. METHODS Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. RESULTS The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) (p<0.01). There were six deaths in the laparoscopic group (11%) compared with 13 in the open group (15%) and one in the converted group (5%). Trainees performed 53% (47/89) of open repairs and 13% (7/54) of laparoscopic repairs. CONCLUSIONS Both laparoscopic and open repair are equally safe in the management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

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Assessment of Circumferential Resection Margins (CRM) clearance in Conventional open Versus Laparoscopic Cancer Rectum Resection

QJM ◽

10.1093/qjmed/hcab097.024 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ibrahim H Bayan ◽

Ahmed Abdelaziz ◽

Tarek Youssef Ahmed ◽

Mohamed Magdy

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Abdominal Surgery ◽

Open Surgery ◽

Laparoscopic Group ◽

Resection Margins ◽

Laparoscopy Group ◽

Surgery Group ◽

Colon And Rectal Cancer ◽

Significant Difference

Abstract Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.

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Impact of SupervIsed TraInIng on the AcquIsItIon of SImulated LaparoscopIc SkIlls

Bulletin of The Royal College of Surgeons of England ◽

10.1308/003588413x13643054410340 ◽

2013 ◽

Vol 95 (6) ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

NA Healy ◽

KH Chang ◽

JB Conneely ◽

C Malone ◽

MJ Kerin

Keyword(s):

Minimally Invasive Surgery ◽

Laparoscopic Surgery ◽

Minimally Invasive ◽

Open Surgery ◽

Alternative Methods ◽

Time Constraints ◽

Laparoscopic Skills ◽

Supervised Training ◽

Initial Learning ◽

Safety Considerations

Laparoscopy or minimally invasive surgery requires surgeons to attain proficiency in skills that are fundamentally different to those required for open surgery. As a result, it both challenges junior trainees and surgeons who are experienced in open surgery. Not surprisingly, the initial learning phase of laparoscopy has been associated with an increased incidence of serious complications. Owing to time constraints and the ethical and safety considerations of allowing novices to perform laparoscopic surgery on patients, alternative methods have been sought to train junior surgeons on the basics of laparoscopic surgery.

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Minimally Invasive Surgery at Paropakar Maternity and Women’s Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v12i2.19943 ◽

2018 ◽

Vol 12 (2) ◽

pp. 16-20

Author(s):

Gehanath Baral ◽

Rijuta Joshi

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Hospital Stay ◽

Histopathological Examination ◽

Mucinous Cystadenoma ◽

Cystic Teratoma ◽

Laparoscopic Hysterectomy ◽

Serous Cystadenoma ◽

Cross Sectional ◽

Benign Condition

Aims: The purpose of this study is to review the reintroduced minimally invasive surgical practice in the hospital after a couple of decades long gap. Methods: It is a two years (2015 to 2017) retrospective cross-sectional study carried out in Paropakar Maternity and Women’s Hospital. The patients with pre-operative diagnosis of benign condition underwent laparoscopic surgery; hysteroscopy was diagnostic and operative both. Data were collected by demographics, indication of surgery, nature of surgery, complications, hospital stay and histo-pathological reports. Data were entered in the SPSS and MS-excel. Results were presented as tables and graphs.Results: Sixty five and 39 women underwent laparoscopic surgery and hysteroscopy respectively. None of them had major complications and hospital stay was1-3 days in majority. The most common age group was 31-35 years. Preoperative diagnoses of them were adnexal tumor in 47 women, fibroid uterus in six, AUB in two, ectopic pregnancies in four, PCOD in two and one women each with primary sub-fertility and POP Q II with elongated cervix. Laparoscopic cystectomy was performed on 25 women for the adnexal masses while 13 women underwent laparoscopic oophorectomy for the ovarian masses. Total laparoscopic hysterectomy was the second commonest surgery (n=12). On histopathological examination of the ovarian tissues, mature cystic teratoma was the commonest finding (n=18) followed by the endometriotic cysts (n=9), benign serous cystadenoma (n=7) and mucinous cystadenoma (n=4). Conclusions: Laparoscopy and hysteroscopy procedures have become the alternative in surgical modality at this hospital.

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Evaluating the Evolving Morbidity of Omentoplasty for Perforated Peptic Ulcer Disease

The American Surgeon ◽

10.1177/0003134820964226 ◽

2020 ◽

Vol 86 (10) ◽

pp. 1289-1295

Author(s):

Noah Swann ◽

Nobel LeTendre ◽

Brian Cox ◽

James Recabaren

Keyword(s):

Laparoscopic Surgery ◽

Laparoscopic Repair ◽

Open Surgery ◽

Surgical Repair ◽

Open Repair ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Patch Repair ◽

Perioperative Morbidity ◽

Graham Patch

Mortality for perforated peptic ulcer (PPU) surgery ranges from 2-22% with morbidity ranging from 15-45%. Traditionally, these had been repaired with vagotomy and antrectomy or pyloroplasty with smaller perforations repaired with an omentoplasty. Laparoscopic repair has become increasingly prevalent and demonstrated to have shorter length of stay (LOS) and fewer complications. We are evaluating the surgical repair of PPU with omentoplasty to determine trends of utilization and surgical outcomes. We conducted a 13-year (2005-2017) retrospective review, utilizing the National Surgical Quality Improvement Program database. A total of 6873 patients had open or laparoscopic repair of a PPU, with 2285 patients identified as utilizing omentoplasty. Five hundred eighty-eight omentoplasty patients were further identified as having a laparoscopic technique. We compared patient demographics, comorbidities, and perioperative morbidity and mortality for surgical patients between 2005-2011 and 2012-2017. We trended the perioperative outcomes across the study intervals. Parametric and nonparametric tests were used to evaluate outcomes. Between 2005 and between 2017, laparoscopic surgical repair with omentoplasty has increased from 3.8% to 34.6%. Overall mortality for open operations declined during this interval (12.7%-9.3%) while it remained unchanged for laparoscopic operations (4.6%-4.2%), there was not a significant difference between the laparoscopic and open 30-day mortality. Both open surgery and laparoscopic surgery are being used on an increasingly healthy cohort (increased functional status decreased predicted perioperative morbidity). Relative to the 2005-2011, the laparoscopic surgery 2012-2017 cohort had increases in both serious and overall morbidity, although this was not statistically significant. Compared to the 2005-2011, the 2012-2017 open surgery cohort had increasing serious morbidity (OR 2.03) and overall morbidity (OR 1.91). There was a trend of decreasing LOS and increased return to the operating room for patients with laparoscopic surgery. Laparoscopic Graham patch repair of peptic ulcers significantly increased, although open repair still constitutes the majority of the cases. Despite Graham patch repair being utilized on a healthier patient population, morbidity and mortality for laparoscopic repair have remained unchanged. Postoperative morbidity and mortality for open surgery have increased. This indicates that laparoscopic repair is more commonly utilized for low- or medium risk patients, leaving an increasingly sick patient population selected to open repair.

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P336 Minimally invasive surgery is safe and feasible for luminal Crohn’s disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.465 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S323-S324

Author(s):

M Nnaji ◽

Y F Chin ◽

O Pujji ◽

B Wilkinson ◽

S Mohan ◽

...

Keyword(s):

Crohn’S Disease ◽

Minimally Invasive Surgery ◽

Laparoscopic Surgery ◽

Crohn's Disease ◽

Open Surgery ◽

Surgical Intervention ◽

Laparoscopic Group ◽

Readmission Rates ◽

Inflammatory Bowel ◽

Reoperation Rates

Abstract Background Crohn’s disease (CD) is an inflammatory bowel condition that still requires surgical intervention in about 70% of cases with laparoscopic surgery increasingly becoming the preferred approach. We present our experience in laparoscopic and open surgery for luminal CD in a DGH setting. Methods This was a retrospective analysis of data collected prospectively between 2008 and 2018. All patients with the diagnosis of CD who underwent a surgical intervention for luminal CD were selected and their demographic, clinical and surgical outcomes data analysed. Results 183 patients were identified. 162 (87%) underwent open and 21 (13%) laparoscopic surgery (p < 0.0001). The median age was 48 years (16–82 years) in the open group and 42 years (16–64 years) in the laparoscopic group(p = 0.05). Male:female ratio was 1:1.2 in the open and 1:1 in the laparoscopic groups. Anastomotic leak rates were lower in the laparoscopic group (0% vs. 2.5%, p = 0.3520). Statistically significant lower readmission rates (9.5% in the laparoscopic, 18% in the open groups, p = 0.0255) and reoperation rates (14% in the laparoscopic and 18% in the open groups, p = 0.0108) were noted in the laparoscopic group. Conclusion Laparoscopic surgery is safe in patients requiring surgical intervention for Crohn’s disease with a notable trend towards improved clinical outcomes.

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MRC SORCE trial: Analysis of patients' presenting characteristics, tumor staging, and surgical approach.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.496 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 496-496 ◽

Cited By ~ 1

Author(s):

Alastair W. S. Ritchie ◽

Angela M. Meade ◽

Louise Choo ◽

Ben Smith ◽

Andrew Welland ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Hospital Stay ◽

Lymph Node Dissection ◽

Surgical Approach ◽

Open Surgery ◽

Node Dissection ◽

Laparoscopic Procedures ◽

Operative Complications ◽

Post Operative Complications

496 Background: SORCE is a randomised double blind trial of sorafenib, given for one or three years, versus placebo for patients at moderate or high risk of disease recurrence after surgical excision of primary renal cell carcinoma (RCC). Methods: Between July 2007 and April 2013, 1,711 patients were recruited from the UK (78%), Australia, France, Belgium, Denmark, The Netherlands and Spain. We describe the presenting characteristics, staging and surgical details of the randomised population. The surgical approach was at the surgeon’s discretion. Results: Baseline information is available for 1,681 patients (98%). Median age was 59 years (range 19 to 86): 1,195 (71%) were male. Histology was conventional/clear cell in 86%. T category was pT1a (<1%), pT1b (11%), pT2 (23%), pT3a-4 (65%). 47% were at high risk of recurrence with Leibovich scores of ≥6. Surgical data are available for 1,528 patients (89%). Total (radical) nephrectomy was performed for 97% of patients with 44% having laparoscopic surgery, of which 60% had a transperitoneal approach and 10% required conversion to open surgery. Some form of lymph node dissection was performed in 25% of patients (33% of open procedures and 15% of lap. procedures). The ipsi-lateral adrenal was removed in 47% and 11% had simultaneous resection of other structures/organs. Excision of venous extension was required in 19%. Laparoscopic procedures were performed for 58% of patients with maximum tumour diameter (MTD) <10cm and 17% of those with MTD ≥ 10 cm. Intra-operative complications were reported in 6% and post-operative complications reported in 12%. Hospital stay was median (IQR) 4 days (3-5) for patients having laparoscopic procedures and 7 days (5-8) for open surgery. Hospital stay was median (IQR) 8 days (6-11) for those having post-operative complications compared to 5 days (4-7) for uncomplicated recovery. Conclusions: These data reveal the varied surgical approaches to excision of primary RCC and will inform future adjuvant trials. The use of lymph node dissection appears arbitrary and evidence of benefit from randomised controlled trials is required. Analysis of the effect of sorafenib on disease free survival is likely to be performed in 2016. Clinical trial information: ISRCTN38934710.

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Laparoscopic Urological Surgery: Our Initial Experiences

Bangladesh Journal of Urology ◽

10.3329/bju.v23i1.50284 ◽

2020 ◽

Vol 23 (1) ◽

pp. 17-23

Author(s):

Shiba Prasad Nandy ◽

AKM Akramul Bari ◽

Anirban Ghose ◽

Hasmot Ali Mia ◽

Md Alamgir ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Hospital Stay ◽

Radical Nephrectomy ◽

Open Surgery ◽

Renal Cyst ◽

Conversion To Open Surgery ◽

Cyst Excision ◽

Excellent Outcome ◽

Duration Of Surgery ◽

The Mean

Introduction and Objective: Laparoscopic surgery is increasingly exercised in urology due to improvements in technical capabilities and experience. It comes with many advantages compared to open surgery such as lesser degree of pain and haemorrhage, shorter hospital stay and better cosmetic results. This study is carried out to evaluate the outcomes and complications of urological laparoscopic surgery cases performed Chittagong Medical College Hospital, Chattogram, Bangladesh. Methods: This was a hospital based prospective observational study of total 29 patients, who received laparoscopic surgery of different kinds between January 2017 and September 2019 for urological causes with a minimum one month follow-up. Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, type of laparoscopic approach, duration of surgery and hospitalization, complications after surgery and need for conversion to open surgery. Results: The mean age was 45.03 years where 12 patients were women and 17 were male. All patients underwent trans-peritoneal procedures where2 patients received renal cyst excision, 4 simple nephrectomy, 5 ureterolithotomy, 9 radical nephrectomy, 1 radical cystectomy, 2 adrenalectomy, 3 pyelolithotomy and 3 pyeloplasty. Three of the 29 patients required conversion to open surgery. Except these patients, no major complication or mortality was encountered. The mean duration of surgery for the most commonly applied procedures were as follows: renal cyst excision 87.5 (70-105) min, simple nephrectomy 141.25 (120-170) min, ureterolithotomy 120 (100-140) min, radical nephrectomy 215.56 (180-260) min, pyelolithotomy 120 (100-140) min, and pyeloplasty 156.67 (130-190) min. The mean hospital stay was 4.59±1.7 (2-8) days. Conclusions: The success and complications rate of the laparoscopic urological surgeries performed in our hospital were consistent with those reported in the literature. In the light of technological advances and increasing experience, we believe that laparoscopic surgery is an effective technique with excellent outcome along with a safe and feasible alternative to open surgery in the field of urology. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.17-23

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TO EVALUATE EFFICACY OF LAPAROSCOPIC TRANSPERITONEAL PYELOLITHOTOMY FOR MANAGEMENT OF RENAL PELVIC STONES IN TERM OF POSTOPERATIVE HOSPITAL STAY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v6i1.2389 ◽

2022 ◽

Vol 6 (1) ◽

Author(s):

Shivek Mohan ◽

Ankit Panwar ◽

Bharat Thakur ◽

Ved Kumar Sharma

Keyword(s):

Hospital Stay ◽

Open Surgery ◽

Laparoscopic Group ◽

Normal Activity ◽

Postoperative Hospital Stay ◽

Medical College ◽

Early Return ◽

Gandhi Medical College ◽

Laparoscopic Transperitoneal ◽

Return To Activity

Background: To evaluate efficacy of laparoscopic transperitoneal pyelolithotomy for management of renal pelvic stones in term of postoperative hospital stay Methods: This study has been conducted in the Department of General surgery, Indira Gandhi Medical College, Shimla on selected patients of Renal pelvis stones admitted in institution Results: Mean hospital stay was 6.66 days in laparoscopic group and it was 8 days in laparoscopic completed by open method. Maximum no. of patients was discharged within 5 days. 6 (75 %) patients returned to normal activity in less than 30 days which included only successful laparoscopic group and 2 patients returned to normal activity in 40 days which included lap completed by open group. Conclusion: In the present study of Laparoscopic Transperitoneal Pyelolithotomy at Indira Gandhi Medical College, Shimla, the procedure showed a definite decrease hospital stay, early return to activity than who have undergone open surgery Keywords: Laparoscopic Transperitoneal Pyelolithotomy, Pelvic stone, Hospital stay.

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Comparison of Perioperative Outcomes in Open and Laparoscopic Radical Cystectomy with Modified Ureterosigmoidostomy (MainzII): A Retrospective Analysis

10.21203/rs.3.rs-805660/v1 ◽

2021 ◽

Author(s):

Bin Zhang ◽

Yang He ◽

Duo Zheng ◽

Junyao Liu ◽

Peng Qi ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Open Surgery ◽

Operation Time ◽

Laparoscopic Group ◽

Postoperative Hospital Stay ◽

Intraoperative Blood Loss

Abstract Background: To analyze perioperative conditions and long-term efficacy of open modified ureterosigmoidostomy urinary diversion (OMUUD) in patients with bladder cancer who underwent open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC).Methods: In this retrospective study, the clinical data of patients who underwent open and laparoscopic radical cystectomy plus open modified ureterosigmoidostomy urinary diversion in our hospital were collected from January 2011 to December 2019. In addition, perioperative data of 56 patients who underwent ORC and OMUUD were compared with those of 118 patients who underwent laparoscopic radical cystectomy (LRC) plus OMUUD. A long-term follow-up was performed to compare the overall survival (OS) and progression-free survival (PFS) rate between the two groups.Results: Results showed that there was no significant difference between ORC+OMUUD group and LRC+OMUUD group in terms of gender, age, body index, pre-operative ASA grade, history of transurethral resection of bladder tumor (TURBT) before surgery, tumor T stage, lymph node dissection range, pathological grade, and positive postoperative surgical margin. The mean operation time in the open group was shorter than that in the laparoscopic group （P<0.001）. Moreover, the estimated intraoperative blood loss（P<0.001）and postoperative hospital stay（P=0.023）were better in the laparoscopic group than in the open group. The incidence of complications between 30 days (P=0.665) and 90 days (P=0.211) time-points after surgery was not significantly different. Similarly, the OS (P=0.237) and PFS (P=0.307) between the two groups were comparable.Conclusion: This study shows that the LRC group has long operation time, but less estimated intraoperative blood loss, short postoperative hospital stay, small trauma, and fast postoperative recovery compared to open surgery. Moreover, the incidence of complications at 30 - and 90-days postoperation, as well as the OS and PFS is not different between laparoscopy and open surgery.

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